Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Mediprobe Research Inc., London, ON, Canada.
Pediatr Dermatol. 2021 Jul;38(4):806-811. doi: 10.1111/pde.14572. Epub 2021 May 17.
Tinea capitis is a common fungal infection in Israel, most commonly caused by the dermatophyte Trichophyton tonsurans.
To investigate the effectiveness of oral antifungal monotherapy in producing clinical or complete cure. We also evaluated the impact of topical therapy (bifonazole 1% shampoo and/or betamethasone valerate 0.1% solution), prior to oral treatment, on patients' likelihood of clinical or complete cure.
A retrospective chart review was conducted. Patients with mycologically confirmed tinea capitis were treated with one of four regimens: (1) terbinafine (greater than 40 kg: 250 mg/day, 20 to 40 kg: 125 mg/day, less than 20 kg: 62.5 mg/day), (2) itraconazole 5 mg/kg daily, (3) fluconazole 6 mg/kg daily, or (4) griseofulvin 20 mg/kg daily. We used generalized linear models (GLM) to determine whether there was a significant association between the odds of cure and choice of treatment.
The causative species was Trichophyton tonsurans in all but 6 cases that grew T violaceum. For pediatric patients, the odds of having complete or clinical cure within 6 weeks was greater if they used terbinafine compared to itraconazole, fluconazole, or griseofulvin (odds ratio [OR] = 9.06, P = .047). The likelihood of complete or clinical cure within 8 weeks of oral therapy was lower if topical steroids were previously used compared to if topical antifungals were used prior to systemic treatment (OR = 0.29, P = .046).
Our findings substantiate prior literature demonstrating that terbinafine is non-inferior to griseofulvin, itraconazole, and fluconazole in the therapy of pediatric tinea capitis caused by T tonsurans.
头癣是以色列常见的真菌感染，最常见的病原体是亲动物性皮肤癣菌须癣毛癣菌。
研究口服抗真菌单药治疗在临床或完全治愈方面的效果。我们还评估了局部治疗（酮康唑 1%香波和/或倍他米松戊酸酯 0.1%溶液）在开始口服治疗前对患者临床或完全治愈的可能性的影响。
对患者进行回顾性图表审查。对经真菌学证实的头癣患者采用以下四种方案之一进行治疗：（1）特比萘芬（大于 40kg：250mg/天，20 至 40kg：125mg/天，小于 20kg：62.5mg/天），（2）伊曲康唑 5mg/kg 每日，（3）氟康唑 6mg/kg 每日，或（4）灰黄霉素 20mg/kg 每日。我们使用广义线性模型（GLM）来确定治愈的可能性与治疗选择之间是否存在显著关联。
除了 6 例生长为紫色毛癣菌的病例外，所有病例的病原体均为须癣毛癣菌。对于儿科患者，如果使用特比萘芬，他们在 6 周内完全或临床治愈的可能性比使用伊曲康唑、氟康唑或灰黄霉素更大（优势比[OR] = 9.06，P =.047）。与使用局部抗真菌药物相比，如果在全身治疗前使用局部皮质类固醇，则在口服治疗后 8 周内完全或临床治愈的可能性较低（OR = 0.29，P =.046）。
我们的研究结果证实了先前的文献，表明特比萘芬在治疗由须癣毛癣菌引起的儿科头癣方面与灰黄霉素、伊曲康唑和氟康唑的效果相当。
